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About this publication
The hospital provider for south east region in Norway asked NOKC to update our previous systematic review on patient volume and quality of care to assess new publications for abdominal aortic aneurysm. This work was undertaken as a rapid review.
We searched for publications in Medline for the period January 2006 to August 2008 that extents our previous search to cover the period back to 1990. We included studies that assessed hospital or surgeon volume and outcomes after surgery or endovascular interventions.
We included seven new studies, that adds to the previously 17 studies assessed in our 2007 report. 20 studies assessed volume-outcome relationship for elective abdominal aortic aneurysm, five studies assessed ruptured abdominal aortic aneurysms, and two assessed thoracoabdominal aortic aneurysm.
High surgeon volume was associated with lower rates of mortality for elective and acute surgery for abdominal aortic aneurysm. Low surgeon volume was defined as less than 5–10 procedures per year.
Hospital volume appears to be of importance, though this was not entirely consistent. Studies from the US and Germany reported lower rates of mortality for patients oper-ated in high volume hospitals. But this was not found in studies from Canada and Finland. The volume thresholds varied, but high volume appeared to be in the range of 40-50 annual procedures.
The two studies that assessed mortality following thoracoabdominal aortic surgery reported lower mortality rates in high volume hospitals.
Hospital volume was not associated with mortality for ruptured abdominal aortic aneurysm.
Most studies were from the US, and quite many studies were publications from the same or overlapping databases. This may give the impression that the literature in this field is more substantial than it actually is.
The actual volume in Norwegian hospitals has increased during the period from 2003 to 2007. Median volume per hospital was 23 in 2003 and 40 in 2007 for open surgery, and 30 and 37 for endovascular procedures respectively.